Pancreatic Cancer Care in the Era of COVID-19: Collateral Damage of the Pandemic

Abstract

Introduction: COVID-19 has challenged healthcare in an unprecedented manner, requiring quarantines and shutdowns to mitigate virus spread. These restrictions may have inadvertently delayed treatment for oncologic diseases. This study aims to analyze the impact of COVID-19 delays on pancreatic cancer care at a quaternary-referral center. Methods: Fifty-six patients who underwent initial surgical resection of pancreatic neoplasms were retrospectively reviewed. The “COVID” group underwent surgery from March 1 – June 30, 2020, the period of limited hospital operations due to COVID-19. The “pre-COVID” control group included patients from the equivalent period in 2019. Time intervals between important clinical milestones and pathologic stage at resection were compared. Results: During the COVID shutdown, the time interval between almost every step in the care pathway was increased. Despite these clinically relevant differences, the only statistically significant difference was found for the time from presentation to pathological diagnosis with an increase of 14 days (p-value = 0.036). With regards to tumor stage, a 14.7% increase in patients presenting with stage III and IV cancer was found in 2020 compared to 2019, however, this difference did not reach statistical significance, likely related to limited sample size. Conclusion: COVID-19 has caused delays throughout the oncologic care pathway, which may have led to more advanced disease at the time of diagnosis. The impact of these delays on patient outcomes requires ongoing investigation to better characterize the collateral damage of COVID-19. To prevent further harm, healthcare systems need to prioritize oncologic patients while the pandemic persists.Tabled 1EP02D-019 Table 1. Time IntervalsInterval in Oncological Care PathwayTime During “Pre-COVID” (median days [IQR])Time During “COVID” (medians days [IQR])P-ValueSymptom Onset → Presentation12 [4.5 - 30.5]20.5 [1.5 - 74.2 ]0.425Presentation → Imaging Diagnosis1 [0 - 6.2]2.5 [0 - 27.2 ]0.414Presentation → Pathological Diagnosis7 [3 - 22]22 [8.2 - 35.8]0.036Presentation → Tumor Board58 [13 - 124]50 [35.8 - 71.8]0.807Pathological Diagnosis → 1st Treatment (Neoadjuvant + Surgical Resection)16.5 [11 - 39.2]20 [7 - 36.8]0.816Pathological Diagnosis → Neoadjuvant17 [16 - 39]25 [14 - 35.2]0.923Pathological Diagnosis → Surgical Resection49 [14 - 126]28.5 [7 - 107]0.663 Open table in a new tab